Rescue hepatectomy for initial graft non-function after liver transplantation

Background. Early retransplantation is the therapy of choice in patients wi th initial graft nonfunction (INF). In rare cases the patients' conditions deteriorate dramatically with severe cardiovascular and/or pulmonary insuff iciency while on the waiting list for retransplantation. In this life-threa tening situation removal of the graft and temporary portocaval shunt before allocation of a new liver proved to be effective. Our experience with this two-stage hepatectomy and subsequent liver transplantation in patients wit h complicated INF is reported. Methods. Hepatectomy was performed in 20 patients with INF associated with severe cardiovascular and pulmonary insufficiency while on the waiting list for emergency liver retransplantation, The mean age was 41.75+/-16.64 year s. The time period between primary transplantation and hepatectomy was 2.80 +/-2.84 days with a range from 1 to 9 days. Results. Hepatectomy reduced the need for vasopressive agents and improved pulmonary function in the majority of patients. Four patients died before a liver was available due to brain death in one patient and multiorgan failu re in three patients. In the remaining 16 patients liver transplantation co uld be performed after 19.82+/-15.34 hr (range 6.58 to 72.50 hr). Two of th e 16 transplanted patients died on the first postoperative day due to multi organ failure and pneumonia. The remaining 14 of 16 patients survived retra nsplantation, but 7 died between days 13 and 105 mostly due to sepsis. Seve n patients were discharged from the hospital in good condition and show lon g-term survival. Conclusion. Hepatectomy was able to stabilize the cardiovascular and pulmon ary function. This study confirms the beneficial effects of hepatectomy and subsequent liver transplantation as a life-saving procedure in patients wi th INF complicated by cardiovascular and/or pulmonary instability.